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Topic: Going to start a business, some things I am shaky on (Read 866 times)

I have been doing medical billing for a year and a half now, and my husband and I are ready to start our own business out of our home. There are just some things that I am not sure on if you could please help.

If a doctor has already been in practice, what all do I need to be able to bill to all insurance companies for him? I know I need his NPI, Tax ID, BCBS #, and Medicare #. What else do I need to get from them to be ready?

And how do you do it if you are signing up a brand new doctor? Do you need to get his NPI and Tax ID for them? I don't know credentialing so they would probably have to hire someone to get them credentialed??

I know it seems obvious, but you need the name of the provider, the name of the practice, if different from just his/her name, the practice address and the billing address (if different, such as a PO Box where payment will be sent), and the phone number. Medicare will be a hassle because whenever there is a change, such as a change of billing agent (that would be you!), a new enrollment form (855I)has to be completed. This can take up to six months or more if things aren't answered correctly the first time (or second, or third....they only give you one wrong thing at a time). You will also need the Medicare PTAN for contacting Medicare for various issues. If Medi-Cal (or Medicaid in other states) is in the mix, it's worse than Medicare. You'll need the specific PIN for that as well.

As far as credentialing, the best bet is for the provider to go to www.caqh.org and complete the extensive application online (or a hard copy can be downloaded) and that will get him/her situated to be credentialed easily with most insurances. Medicare and Medicaid, of course, are not included in that. I have helped some of my clients get signed up as providers but sometimes they are willing to do it themselves. If they have front office staff, it could fall on them to do it. It just depends on what services you are willing to provide. When you are meeting with a potential client, that's one of the things you'll want to discuss.

I started my own billing service with a friend in 1996. We only had one client for a year (we worked full time elsewhere) and all the money went back into the business. Being in a rural area, there wasn't a huge pool of doctors, but we eventually built it up to where it's a pretty good income for me. I now own the business by myself. The best thing is the flexibility of hours and the fact that I can make as much money in half the time as I could as a biller in an office setting.